If the hæmorrhage be really profuse, it shows that the separation of the
ovum from the uterus must be of considerable extent; and as there will be
no chance of preserving the life of the foetus under such circumstances,
the expulsion of the ovum is no longer to be avoided, but rather to be
promoted; our attention therefore must now be directed to assist the
uterus in the evacuation of its contents, with as little injury and danger
to the mother as possible. It is, however, no easy matter to decide with
certainty when we must give up all hope of preserving the ovum, for a
large quantity of blood may be lost without expulsion being a necessary
consequence. Uterine contractions may have even taken place, and yet by
careful management the mischief may be sometimes averted, and the patient
be enabled to go her full time. Even where they have been of sufficient
force and duration to dilate the os uteri, we are not justified in
discontinuing remedial measures unless the flooding has seriously affected
the patient's strength, and the ovum be actually projecting through the os
uteri. "We might often prevent abortion (says Baudelocque) if we were
perfectly acquainted with its cause, even when the labour is already
begun. A very plethoric woman felt the pains of childbirth towards the
seventh month of her pregnancy, and the labour was very far advanced when
I was called to her assistance, since the os uteri was then larger than
half a crown; two little bleedings restored a calm, so much that the next
day the orifice in question was closed again, and the woman went the usual
time. Food of easy digestion prudently administered quieted a labour not
less advanced in another woman, where it was suspected to be the
consequence of a total privation of every species of nourishment for
several successive days. Delivery did not take place till two months and a
half afterwards, and at the full time. Emollient glysters and a very
gentle cathartic procured the same advantage to a third woman, in whom
labour pains came on between the sixth and seventh months of pregnancy,
after a colic of several days' continuance, accompanied with diarrhoea and
tenesmus." (_Baudelocque_,) § 2232. Nor is it always easy to decide
whether it be the ovum or not which we feel protruding through the os
uteri. "When the abortion is in the second or third month, the
practitioner must bear in mind that it may have been retention of the
menses, and, therefore, what he feels in the os uteri may either be an
ovum or a coagulum of blood. To decide this point he must keep his finger
in contact with the substance lying in the os uteri, and wait for the
accession of a pain (for where clots come away, pains like those of labour
are present,) and ascertain whether the presenting mass becomes tense,
advances lower, and increases somewhat in size; this will be the case
where it is the ovum pressing through the os uteri. On the other hand, if
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